Details Of The New Health Care Reform Bill

‘Building Toward Full Coverage And A Healthier, Better Future’

MAJOR GOALS

Cover 90-95% of the uninsured in Massachusetts over the next three years

Reduce the cost of health care for consumers, businesses and taxpayers

Empower consumers through choice, quality care and comparative information

Continue to invest in health care, a key component of our state’s economy

Improve the public health of the Commonwealth for all its citizens

Reduce the use of free care at hospitals and community health centers

Strengthen economic competitiveness

KEY ELEMENTS

Employer and Individual Responsibility

New “Fair Share Contribution” & “Free Rider Surcharge” to encourage employers to contribute toward employee coverage

Require all residents to purchase or retain health insurance coverage beginning July 1, 2007, so long as affordable coverage is available.

These incentives oblige businesses and individuals to work toward full health insurance coverage

MassHealth Program

Maximize enrollment of currently eligible but unenrolled eligible citizens (40,000 individuals)

Expand MassHealth eligibility for children up to 300% Federal Poverty Level (FPL) (27,000 individuals)

Raise enrollment caps on existing programs, including MassHealth Essential, CommonHealth, and MassHealth HIV (18,000 individuals)

Expand the Insurance Partnership program for employees up to 300% FPL (7,500 individuals)

Estimated Number of Additional Covered Lives by FY09: 92,500

Commonwealth Care Health Insurance Program

New program to assist low-income families and adults to purchase insurance with no annual deductible

Low-income uninsured adults (below 100% FPL) to access comprehensive private insurance with no monthly premiums or deductibles (65,000 individuals)

Require enrollees above 100% FPL to contribute toward the purchase of insurance based on a sliding-scale premium schedule (150,000 individuals)

Require enrollees to contribute toward the purchase of insurance based on a sliding-scale schedule

Allow low-income uninsured adults (below 100% FPL) to access comprehensive private insurance with no monthly premiums or deductibles.

Meet the terms of the federal waiver agreement and secure $385 million in federal funding

Permits private insurers to offer new, affordable policies to small business and individuals, including low-cost products specifically designed for young adults

Markets to small businesses and reduces administrative costs

Makes it easier for all businesses to offer insurance to their contractors and part-time workers

Estimated Number of Additional Covered Lives by FY09: 207,500

Private Market Reforms

New Commonwealth Care Health Insurance Connector Authority to enable individuals and businesses to purchase health insurance with pre-tax dollars

Encourage insurance companies to offer low-cost products through the Connector, including products specifi cally designed for young adults

Connector to market products to small businesses and reduce administrative costs

Reduce cost-shifting to private insurance by increasing Medicaid rates for providers and minimizing the use of the free care pool

Establish Market-Based Reforms

Spur private insurers to off er affordable health insurance benefits to small businesses and others who cannot afford insurance today

Require health plans to offer family coverage to young adults up to age 25

Place a moratorium on all new mandated benefits and study their economic impact

State board and website comparing cost and quality of health care from different hospitals and providers to enable consumers to find the most efficient quality care

Creates a Commission to study and make recommendations regarding possible reforms to the current insurance market aimed at reducing costs, including merging non-group and small-group markets, reinsurance, and coding reform

Estimated Number of Additional Covered Lives by FY09: 215,000

Establish Long-Term Savings, Improve Public Health

Set of reforms and investments to curb long-term cost inflation by improving the efficiency of the market and expanding prevention programs

Increase funding for certain prevention programs (cancer screening, diabetes education, etc.)

Restore certain health benefits to all MassHealth members including dental coverage

Reduce cost-shifting to private insurance by increasing Medicaid rates based on provider performance

Invest $5M for Computerized Physician Order Entry Systems initiative that reduces medical errors

Establish Employer And Individual Health Care Incentives

Encourage responsible employer and consumer behavior regarding health care coverage

New “Fair Share Contribution” & “Free Rider Surcharge” to encourage employers to contribute toward employee coverage

Require all residents to purchase or retain health insurance coverage beginning July 1, 2007, so long as affordable coverage is available

TOTAL COVERAGE

Total Estimated Additional Covered Lives by FY09: 515,000